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Home My WebLink About03116 t y ~'• GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit N ^ _ 3 1 16 rt I 109 8th Street Suite 303 Assessor's Parcel No. i, i Glenwood Springs, Colorado 81801 Phone (303) 945 -8212 ' i '* This does not constitute i y . i INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. ; k t PROPERTY '1 i \ ty��,, p� � I n / ^ U�1 w • r i t Owner's Name 1 dEln I Afryl Present Address 74 inca49o^site P ins. / Tom- 55 (7 a c u System Location - ; t r Leg's P rcel No . „ al Description of Assessor( r�krlock- Lc- stcH rfc- �p(zo /e) ---� 1 , o �� SYSTEM D S((i► �! 1. E A Fr C 1I 'A �c G2 G OS V / ?S i e 7 "" 'T 6t 7: ro4Pi - . - ® s Sept Tan Cap acity ( Other Z.J H • T / . (6> r m I $ I 1 1 I Percolation Rate (minutes /inch) Number of Bedrooms (or other) e � . i . ' Required Absorption Area - See Attached ;y j{ ' t Special Setback Requirements: i n t; Date 3-- 9 Inspector 0 ` N es /. ( { t' FINAL SYSTEM INSPECTION AND APPROVAL (as installed) 1 r Call for Inspection (24 hours doe) Before Covering I stallation� i- t. � ''o . • e ,, System Installer O 111 �A 5 v , C Septi Tan Capacity ` � S Septic Tank Manufacturer or Trade Name jay V ' 1 . � F ' t • Septic Tank Access within 8•• f surface J Absorpt A rea _ � . S /� 1 ti � J [ '1 Absorption Area Type and /or Manufacturer or Trade Name . V 1'J)'� 7/ 11 1 i, r i Adequate compliance with County and State regulations /requirements " . t O ther t r e ' 1� 5 — 91 �i Date Inspector 1 RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE i ) ;L . I' ' *CONDITIONS: ' 1. All installation must comply with all requirements of the Colorado State Board of Health Individual Sewage Disposal Systems Chapter 25, Article 10 C.R.S. 1973, Revised 1984. . a i' 2. This permit is valid only for connection to structures which have fully complied with County zoning and building requirements. Con- `i r' nection to or use with any dwelling or structures not approved by the Building and Zoning office shall automatically be a violation or a requirement of the permit and cause for both legal action and revocation of the permit. { 3. Any person who constructs, alters, or installs an individual sewage disposal system in a manner which involves a knowing and material variation from the terms or specifications contained in the application of permit commits a Class I, Petty Offense (6500.00 IIne — 8 v months in )all or both). ., ,, t; - - White - APPLICANT Yellow - DEPARTMENT ____ _ . r , INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION OWNER .2 A/\ 1\1 Moon) ADDRESS 1 M E1■4s4 Lane le \O ) 00 . PHONE 414 CONTRACTOR ELokv 2ocaYC ADDRESS 01300,1 l £90D PHONE C l'f$ - 5 - 5 - t 9' PERMIT REQUEST FOR ( ) NEW INSTALLATION ( ) ALTERATION »EPAJR Attach separate sheets or report showing entire area with respect to surrounding areas, topography of area, habitable building, location of potable water wells, soil percolation test holes, soil profiles in test holes (See page 4). LOCATION OF PROPOSED FACILITY: qk (q-D,bc S9 W Near what City of Town & ENWaoo SQrifr1&5 Size of Lot Z Go X t 69 Legal Description or Address Los{- 31 v. nsr1/4 t4 dCtF S 4 MVisiw+1 F Ii■ c 4 t1i444 C+ WASTES TYPE: (JI DWELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES ( ) OTHER - DESCRIBE BUILDING OR SERVICE TYPE: Number of Bedrooms y Number of Persons `i Garbage Grinder Automatic Washer 00 Dishwasher SOURCE AND TYPE OF WATER SUPPLY: ( ) WELL ( ) SPRING ( ) STREAM OR CREEK If supplied by Community Water, give name of supplier: ttRAr/k DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: Yr\, I-t S Was an effort made to connect to the Community System? A site Ulan is required to be submitted that indicates the followine MINIMUM distances: Leach Field to Well: NIA- 100 feet Septic Tank to Well: 50 feet Leach Field to Irrigation Ditches, Stream or Water Course: 50 feet Septic System to Property Lines: 10 feet YOUR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT WILL NOT BE ISSUED WITHOUT A SITE PLAN. GROUND CONDITIONS: Depth to first Ground Water Table Percent Ground Slope 2 r ,TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: SEPTIC TANK ( ) AERATION PLANT ( ) VAULT ( ) VAULT PRIVY ( ) COMPOSTING TOILET ( ) RECYCLING, POTABLE USE ( ) PIT PRIVY ( ) INCINERATION TOILET ( ) RECYCLING, OTHER USE ( ) CHEMICAL TOILET ( ) OTHER - DESCRIBE FINAL DISPOSAL BY: 94 ABSORPTION TRENCH, BED OR PIT ( ) EVAPOTRANSPIRATION ( ) UNDERGROUND DISPERSAL ( ) SAND FILTER ( ) ABOVE GROUND DISPERSAL ( ) WASTEWATER POND ( ) OTHER - DESCRIBE WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? /\f PERCOLATION TEST RESULTS: (To be completed by Registered Professional Engineer, if the Engineer does the Percolation Test) Minutes per inch in hole No. 1 Minutes per inch in hole NO. 3 Minutes per inch in hole No. 2 Minutes per inch in hole NO. Name, address and telephone of RPE who made soil absorption tests: Name, address and telephone of RPE responsible for design of the system: Applicant acknowledges that the completeness of the application is conditional upon such further mandatory and additional tests and reports as may be required by the local health department to be made and furnished by the applicant or by the local health department for purposed of the evaluation of the application; and the issuance of the permit is subject to such terms and conditions as deemed necessary to insure compliance with rules and regulations made, information and reports submitted herewith and required to be submitted by the applicant are or will be represented to be true and correct to the best of my knowledge and belief and are designed to be relied on by the local department of health in evaluating the same for purposes of issuing the permit applied for herein. I further understand that any falsification or misrepresentation may result in the denial of the application or revocation of any permit granted based upon said application an• n legal action for perjury as provided by law. Signed j Date 3-1(0 PLEASE Pi' W AN ACCURATE MAP TO YOUR PROPERTY!! 3 MAR -24 -99 WED 09:13 AM HIGH COUNTRY ENGINEERING FAX NO. 970 945 2555 P. 01 _ _ IMPROVEMENT LOCATION CERTIFICATE ille4bevi MEAC LANE — ___ N o I I ____`_,___' I WI1. 1 &LN..E 1 "cho' 1 1 I of I 'L cIsTOP'( FP.A"1E I ;. LOT 3; _ I .. 'S PLIT LF VCL.. t 1 � ,9• I . -1 1 Q' tl' % 46s'y K ,. 1 I Leg. t o.2: 1 ' H- d 1 !ti. \ r L vEL '9 I t- , r9 : 1 I V AU_•ou-r (4 I 9 co' E. . . h, ,AI.�. WITH RR - M I CONIC. In f."C1 J8 NG WALL 1 PAD 2 :I ' I ` 1 1 .'S't LkIve._ { I GANTII_ev6VY 111 1 �V , ' 24 • pp 1 y� o I .' e' Q I •• a '� 8 • r R ,.o' Ia. .. - N 1 ;- I • PiePeato ww 44 aid i_L:T'a,4 I 1,04 i 9 w t. 'I � --r.5' UTILITY �tS a /"1 AL.OI1 1 ALL- )1 t.arta•A - LEGAL DESCRIPTION LOT 33, W1STDANK RANCH SUBDIVISION, FILING 43, OARCIELD COUNTY, COLORADO. IMPROVEMENT LOCATION CERTIFICATE I hereby certify that this improvement location certificate was prepared for UNITED FARM AGENCY , THAT IT IS NOT A LAND SURVEY PLAT OR IMPROVEMENT SURVEY PLAT, and that it is not to be rol.iod upon for the ostablishmont of Pones, building, or other future improvement lines. I further certify that the improvements on the above described parcel on this dato, November 11, 1980 , except utility oonnootions, aro entirely within the boundaries of the parcel, except au uhown, that there are no encroachments upon the des- cribed premises by improvements on any adjoining premises, except as indicated, and that there is no APPARENT evidence or sign of any easement crossing or burdening any p art of said parcel, except an noted. '� •Y 0` C:t.AYCOMR DY ENGINEERING DAT oval •I- ' yy .11,` 'sY ' ASSOCIATES, INC. 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